LCD L37643: Routine Foot Care

Background

Generally, routine foot care is excluded from coverage. Services that normally are considered routine and not covered by Medicare include the following, regardless of the provider rendering the service:

• Cutting or removal of corns and calluses;

• Trimming, cutting, clipping or debridement of nails, including debridement of mycotic nails;

• Shaving, paring, cutting or removal of keratoma, tyloma and heloma;

• Non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage;

• Other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet, the use of skin creams to maintain skin tone of either ambulatory or bedfast patients;

• Any other service performed in the absence of localized illness, injury or symptoms involving the foot.

There are exceptions to routine foot care exclusions. This local coverage determination (LCD) outlines such exceptions.

Indications

Routine foot care services are subject to national regulation, which provides definitions, indications and limitations for Medicare payment of routine foot care services.

Exceptions to routine foot care exclusions include:

• Routine foot care that is necessary and an integral part of an otherwise covered service;

• Treatment of warts on foot;

• The presence of systemic conditions, such as metabolic, neurologic, or peripheral vascular disease;

• Mycotic nails:

• In the presence of systemic conditions as noted above in #3.

• In the absence of systemic conditions:

• An ambulatory patient must have marked limitation of ambulation, pain or secondary infection resulting from the thickening and dystrophy of infected toenail plate.

• A non-ambulatory patient suffers from pain or secondary infection resulting from the thickening and dystrophy of an infected toenail plate.

Presumption of Coverage

In evaluating whether the routine services can be reimbursed, a presumption of coverage may be made where the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement. For purposes of applying this presumption the following findings are pertinent:

Class A Findings

• Nontraumatic amputation of foot or integral skeletal portion thereof.

Class B Findings

• Absent posterior tibial pulse;

• Advanced trophic changes as: hair growth (decrease or absence), nail changes (thickening), pigmentary changes (discoloration), skin texture (thin, shiny), skin color (rubor or redness) (three required) and;

• Absent dorsalis pedis pulse.

Class C Findings

• Claudication;

• Temperature changes (e.g., cold feet);

• Edema;

• Paresthesias (abnormal spontaneous sensations in the feet) and;

• Burning.

The presumption of coverage may be applied when the physician rendering the routine foot care has identified:

• One Class A finding;

• Two of the Class B findings; or

• One Class B and two Class C findings.

Limitations

1.Covered exceptions to routine foot care services are considered medically necessary once (1) in 60 days.

2.The exclusion of foot care is determined by the nature of the service, regardless of the clinician who performs the service.

Loss of protective sensation (LOPS) is not the subject of this LCD.

N/A